E-Cigarettes: Public Health Hazard or Key to Quit Smoking?

Scientific studies showing that electronic cigarettes actually help people quit smoking are few and far between. But that isn't stopping many smokers, as well as a few experts, from giving e-cigarettes the benefit of the doubt.

A new controversial opinion piece goes so far as to suggest that e-cigarettes could bring about the "demise" of traditional smokes, and save thousands of lives in the process. The only thing holding these smokeless devices back from much wider use is that people know they aren't regulated, and so some are less likely to use them, according to Dr. Nathan Cobb, assistant professor of medicine in the division of pulmonary and critical care at Georgetown University School of Medicine.

E-cigarettes are battery-powered devices that hold liquid solutions containing nicotine, and deliver the drug as a vapor, but don't contain tobacco or produce smoke. Studies have shown that the devices contain fewer chemicals than traditional cigarettes, but their effects on health are not clear. [4 Myths About E-Cigarettes]

The trouble with e-cigarettes today is that they're a kind of "black-market nicotine therapy," Cobb told Live Science. In other words, people could use these devices to wean themselves off nicotine in much the same way they might use more conventional nicotine replacement therapies (NRTs) — for example, the patch, nicotine gum or nasal sprays. But unlike other NRTs, e-cigarettes aren’t regulated by the U.S. Food and Drug Administration (FDA).

"When you go and you buy a black-market TV, you have no idea if it's going to work like you think it's going to work. You have no idea who made it, if it's real, if it's going to blow up," said Cobb, who went on to say that the same thing is true of e-cigarettes.

Taking electronic smokes off this so-called black market by subjecting them to greater regulation would be taking a product that's already popular with those trying to quit smoking and making it safer, Cobb said. This might be easier than trying to make the NRTs that have already been proven to be safe more popular, Cobb suggested.

"Nicotine replacement works — it doubles quit rates. But it has terrible reach. The number of smokers in the country who actually use it is poor," said Cobb, whose editorial is published in the Thursday (Oct. 16) issue of the New England Journal of Medicine.

Even if e-cigarettes aren't as effective in helping people quit as these other forms of nicotine replacement therapy — a question that requires much more research — Cobb still thinks the devices could play a part in reducing smoking rates in the United States. Because of their popularity, electronic cigarettes have the potential to help three times as many people quit smoking as conventional NRTs, he said.

However, not everyone is as enthusiastic about the potential role of e-cigarettes in public health as are Cobb and his co-author, David Abrams, who is executive director of the Schroeder Institute for Tobacco Research and Policy Studies at the Legacy Foundation in Washington, D.C.

"This commentary assumes that e-cigarettes, as currently in the marketplace, will help people quit smoking and ignores the consistent evidence from population-based studies that smokers who use e-cigarettes are about one-third less likely to quit smoking," Stanton Glantz, a professor of tobacco control at the University of California, San Francisco, told Live Science in an email.

A recent study in the journal Cancer found that cancer patients who tried to quit smoking using e-cigarettes were actually more nicotine-dependent, and twice as likely to still be smoking at the study's end, than cancer patients who tried to quit without using e-cigarettes.

Other experts agree that more comprehensive research needs to be conducted in order for medical professionals to move ahead with public health policies that position e-cigarettes as cessation aids for smokers. In the meantime, it's simply too early to tell whether or not e-cigarettes are really effective at getting people to stop smoking, according to Dr. Michael Steinberg, director of the tobacco dependence program at Robert Wood Johnson University Hospital in New Jersey.

"The authors are starting from the position of comparing e-cigarettes to FDA-approved nicotine medications. The problem is that although we have an exhaustive source of scientific studies demonstrating the safety and efficacy of NRT, no such evidence base exists for e-cigarettes," Steinberg told Live Science in an email.